Day Centres as Meeting Places and Turning Points in the Rehabilitation Pathway Paolo Francesco Peloso and Lucia Valentini Dept of Mental Health and Substance Abuse, Genoa, Italy

Mental Health Centre (MHC) is defined as a service aiming to: Provide outpatient psychiatric care to general population Offer long term outpatient service to people with severe mental health problems Provide recreation and rehabilitation activities assisted by health workers Offer, when needed, sheltered accomodation Most Italian Community Mental Health Centres, however, only fulfill the two first objectives. Article’s question: How to meet the third need?

Generally separated from the MHCs Day Care “[...] a semi residential structure with therapeutic and rehabilitation functions aimed to prevent and limit hospital admissions. [...] Services include a range of occupational programs focused on the acquisition of skills tht may be employed in a work setting.” Generally separated from the MHCs Number of patients range depending on the size of the facility and type of activity undertaken Limited time, concluded with full introduction within society and work Usually open 5 days a week

Staying-Oriented Model Work toward preventing psychiatric hospital admissions and reducing symptoms by taking advantage of the residual abilities Welcome and affective, possibility of finding emotional residence. – “Here I can be myself and be accepted” Provide opportunities for resocialization, rescuing patients from isolation. The social contact itself performs the function of therapy Problem: Some people don’t fully heal, reaching a state of chronicity, which makes discharge extremely difficult

Activity-Oriented Model “Shelter Workshop” – foster the development of work skills in order to make disabled subjects capable of performing activities Subjects feel useful and productive Risk of presenting illusory expectations for possible long-term adaptation in a real workplace Persons who cannot engage in activities or cannot function at sufficient level may eventually be excluded

Model Oriented on Going Beyond Personalised rehabilitation projects Transfer the focus from the health worker’s interests to the patient’s needs Client’s decision making ability is taken into account Focus on patient’s discharge

Day Centre x Mental Health Hospital Allows people to spend their lives in non-institutional environments Limit person’s dependency on psychiatric institution and preserve their autonomy Improvement of a person’s behaviour within their own environment Problem: “New Chronicity” Problem: Lack of Public Health support Problem: Challenging clients Conclusion